TroubleShoot & Self-Care

Troubleshooting with the E-Arches

If the patient is under 12, the baby teeth that the E-arches are attached to may loosen or even fall out. If this should happen, remove any loose parts and call us. Be sure to save anything loose and bring these parts to your next appointment. It is also possible for the “arms” to spring apart toward the end of their function. This is not a problem. Call us and we can put them back together. Sometimes a loose tooth will allow the “arms” to spring out over the biting surface of the teeth. If this should happen, please call us right away so that we can adjust this appliance.

Troubleshooting with RPE

Depending on Dr. Garrett’s instructions, the R.P.E. should be turned 1 to 2 times a day. A space should be developing between the front teeth. If this is not happening during the first visit, or after the insertion of the appliance, please let us know. The problem may be a faulty screw or improper turning. If severe pain is experienced after the turning of the screw, please let Dr. Garrett know right away. If a band should loosen, please call us right away and continue to use fluoride rinse twice a day until Dr. Garrett can see you.

Poking Tie Wire (Pig Tail)

Bend the wire back with a spoon or a pencil eraser. If this is unsuccessful, cover it with wax and call us to schedule an appointment.

Wire out of Tube

Try to place the wire back into the tube with tweezers. Place wax if uncomfortable. Call us to schedule an appointment.

Flexible Archwires

Usually the first archwires we use will be flexible. Sometimes they may come out of the back molar tube, because they have shifted to one side or the other. This can happen. If you have locking eyebrow tweezers, you can grab the wire gently but firmly and place it back into the tube. It may be slightly bent, but it can be fed back into the molar tube if you push it firmly. You can also take a piece of floss and tie the wire to the molar tube until a member of the staff can see you.

Troubleshooting with the Herbst Appliances

These appliances cause most of their mischief when they are first inserted. They cause soreness until the patient is used to the appliance. Please place wax or EZO denture cushions over the offensive areas. It is also a good idea to keep cheek pads between the appliance and the insides of the cheek. Do this at night or when getting used to the appliance “arms”.

Be aware of the “shims” (sleeves of metal used for advancing the Herbst). Be sure to check screws daily for tightness.

Be careful eating foods that are hard, or chewing on pencils. These items will bend the arms of the Herbst or they could loosen the crowns. Do not open your mouth and “play” by moving your jaw from side to side. We find that this may bend the rods and will cause a problem opening and closing properly.

Developing “holes” in the cheeks around the upper outside of the Herbst can be a problem. Once the “hole” develops, it becomes sore. The key to healing the soreness is to keep it clean, but no one wants to keep it clean because it is sore, so it gets worse. There are methods for preventing a “hole” from developing. Keep the cheek pads (Dri-Angle) between the cheek and the Herbst, especially at night when sleeping, so that resting on your cheek will not cause the “hole”. Massaging the area with an extra soft toothbrush will help as well. Cleaning the area with numbing medicines containing benzocaine, such as orabase, zilactin, anbesol, etc., are very helpful to use prior to cleaning.

Troubleshooting Archwires

Sometimes archwires begin to poke or pinch at the end of the wire behind the molar brackets. This can sometimes happen when power chain is put on (powerchain is an elastic-like item used on each bracket to draw the teeth together in order to close spaces).

After it draws the teeth together, it leaves some extra length of wire at the end because the teeth have come closer together. This is normal. However it can be painful.

Follow these guidelines until a member of our staff can see you:

Put some wax over the very end

Put an EZO denture cushions over the very end

Place a cheek pad (Dri-Angle) between the wire and the cheek. A piece of an index card will do the same. The index card will stick to the inside of the cheek. This will keep a barrier between the cheek and the sharp end.

Lost Tie Wire or Elastic Tie

Call us to schedule an appointment.

If you have accidents involving your teeth, call your Dentist or Orthodontist immediately!

Shifted Archwire

Try to slide the wire back around the other side. If this is not successful, place wax on the wire and call us to schedule an appointment.

Pokies

Pokies come in all shapes and sizes. A ligature tie causes most pokies. A ligature tie is a thread-like steel tie used to hold in the archwire. The ligature tie is put around the bracket and twisted tightly. The end is cut and tucked under the archwire or bracket. Sometimes it will move and poke your cheek or lip. If this happens, use an eraser or spoon (something dull) and push it out of the way.

A small hook welded to a band or bracket can also be a pokie. They can sometimes irritate your lip or cheek. There is not much you can do without breaking the bracket. But you can apply wax or an EZO denture cushions over the area, until a member of the staff can see you.

Troubleshooting with the Distal Jet

Be careful and watch your diet. Eating the wrong foods can loosen these appliances and cause set backs in the progress. Keep the area around the TAD and the Distal Jet clean by brushing, rinsing with salt water and peroxide and cleaning with a waterpik flosser, or dental floss. We recommend a waterpik flosser. This is your job and it is important.

Sometimes the back teeth are moved in such a way as to allow the “bend” of this appliance arm to embed in the palate tissue. Please call right away if you feel this is happening. We can adjust this to make you more comfortable.

Loose Bracket (Bond)

If the bracket or band is still attached to wire, leave it in place. If it is uncomfortable, cover it with wax. If it comes out completely, bring it with you to the next appointment. DO NOT CONNECT ELASTICS TO A LOOSE BAND! Please notify our office (540) 667-5446 to inform us of the loose band/bond. We may adjust the appointment to allow for repair.

Soreness from Braces

Rinse the mouth with warm salt water. If necessary, take the pain reliever you would normally use for a headache or a similar discomfort.

Poking Archwire

Cover with wax or wet cotton. Call us to schedule an appointment.

Rubber Bands (Elastics)

Rubber bands are used to “coordinate” the upper and lower arches together. They can be used to correct an overjet (the distance the upper front teeth protrude past the lower front teeth). They can also correct an open-bite (when the upper and lower teeth don’t touch when biting). They can also correct a Class III occlusion (when the lower front jaw protrudes past the upper front jaw). There are a number of positions in which elastics can be worn. The aforementioned positions are more frequent.

When patients wear the rubber bands (elastics), they have been placed with great responsibility and control over their orthodontic care. If worn properly, they will correct approximately 1 mm within a 4-week period of time. Full time wear means just that, FULL TIME. We recommend you remove elastics to brush only. Changing elastics at least 1 time a day to maintain a good force or when they break will accelerate the success of the wear. Wearing them when eating will generate more force and speed up the progress.

Whatever the position of the elastics, it is important to pay close attention when shown how to wear them. Improper wear can actually cause problems. This can extend your treatment period. If you are afraid you will forget where to place the elastics, ask your technician to print the position for you

Invisalign braces are a type of custom made clear, plastic, removable teeth aligners that are nearly invisible on the teeth. Invisalign appeals to adults and teens who want something different than the traditional metal braces. It is a great option for adults and teens who are compliant and motivated. Dr. Garrett will answer any question for you individually and make the most appropriate recommendations.

Advantages of Invisalign for Adults and Teens

Invisalign braces are nearly invisible and are not obvious to anyone that you are wearing them, which heightens the esthetic appeal.

They do not stain, which also helps with the esthetic appeal.

They are removable, allowing for better oral hygiene and fewer restrictions on diet.

They are more comfortable and do not irritate the gums, which leaves little need for dental wax.

The clear aligners are numbered and worn for one or two weeks each depending on your treatment plan, so treatment time is well-established.

Computer simulation shows how teeth will move during treatment and the projected final outcome can be seen.

Garrett Orthodontics uses a scanner to determine the most advanced diagnostic information as well as eliminating the need for messy impressions.

Like Invisalign for adults, Invisalign Teen is a series of custom-made, clear plastic aligners that provide a teeth-straightening alternative to more traditional metal braces. Invisalign Teen is designed to help teenagers maintain their self-confidence and accommodate their active lifestyles during orthodontic treatment, giving them a reason to smile!

Invisalign Teen combines the benefits of the Invisalign system with new features, such as the Blue Dot Wear Indicator that fades when the aligner becomes worn and is ready to be changed; Eruption Tabs to accommodate the growth of second molars; and other features to address clinical needs common to teens.

Invisalign Teen Treatment: What’s Involved?

Invisalign Teen can be used to correct some overly crowded teeth, widely spaced teeth and overbite. Only an experienced orthodontic specialist, like Dr. Garrett, can determine if Invisalign Teen is the right orthodontic treatment for you.

During your consultation, pictures and of the teeth are taken and a panoramic x-ray is made to discuss treatment with Invisalign. Then the computer scanner is made and 3D technology maps tooth movements from the beginning to end of treatment, creating your customized aligners. Treatment time varies with every patient but an estimate may be advised as a reference since every patient’s needs are different.

The clear aligners must be worn every day for 22 hours which means all the time except for when eating, brushing or attending special occasions. A new set of aligners are provided every one or two weeks to strategically straighten teeth.

Advantages of Orthodontic Treatment for Teenagers

During Invisalign Teen treatment, teenagers can play sports, play musical instruments and keep up their active social lifestyle with a spontaneous smile. Removable aligners promote better oral hygiene, as well as less irritation to the gums and mouth. Extra office visits for broken braces or wires are eliminated.

We welcome our traditional braces patients from Stephens City, Strasburg, Berryville, Winchester, Front Royal and surrounding areas of Jefferson County, Warren County, Frederick County and Clarke County in VA and WV.

Metal Braces

Metal brackets can be silver or golden. The are very strong and can withstand most types of treatment. At first, gums and cheek tissue may become irritated, but there are several first aid tricks to deal with the discomfort such as saltwater rinses and applying wax to the metal brackets.

Most traditional metal braces require an elastic O-shaped rubber band, called a ligature, to hold the arch wire onto the bracket. Sometimes metal tie wires (wires that twist around the bracket) are used in place of elastic ligatures.

Years ago, metal braces were not just brackets, but a band that wrapped around each individual tooth. Today, small metal brackets are glued to the front of each tooth (much less fuss). The old type of bands are usually reserved for molars or teeth with fillings that overlap to the outside surface of a tooth. Metal brackets tend to be less expensive than other types of brackets. And now, choices of colorful ligatures are available in a rainbow of colors to individualize personal style.

Advantages of Metal Braces

Treatment time is usually comparable to that of Invisalign.

You can choose a darker ligature, which hides curry, smoking or black coffee stains.

Self-ligating braces do not contain rubber ligatures, so staining will never be a problem.

They are strong and rarely break.

Golden brackets are unique, novel and generally look attractive.

Advantages of Metal Braces

Treatment time is usually comparable to that of Invisalign.

You can choose a darker ligature, which hides curry, smoking or black coffee stains.

Self-ligating braces do not contain rubber ligatures, so staining will never be a problem.

They are strong and rarely break.

Golden brackets are unique, novel and generally look attractive.

Ceramic Braces

Ceramic brackets are made of composite materials. They are very strong and usually do not stain. Adults like to choose ceramic because they are more in color harmony with the teeth and are less noticeable than metal.

Advantages of Ceramic Braces

If teeth are not perfectly white, ceramic brackets blend in and are not as noticeable at a distance or in photos.

Sometimes they are more comfortable than metal and irritate gums less.

Ceramic brackets are very strong, and when bonded with a plasma light, stay on as well as metal brackets.

Disadvantages of Ceramic Braces

Clear or white ligatures (little elastics that hold the arch wire to the brackets) sometimes stain. However, they are changed during adjustments.

Treatment may take a few months longer with ceramic braces.

From an esthetic viewpoint, they are slightly larger than metal brackets.

With severe conditions, ceramic brackets will not be strong enough to withstand the force of some types of treatment.

The E-arch is used to widen the upper and or lower jaws to make room for permanent teeth. The appliance has two crowns or bands usually positioned on the baby molars or permanent 6-year molars. From the crown on one side is an L-shaped sleeve, and on the opposite side is an L-shaped arm which is attached to the opposing crown.

Between the two “arms” is a spring, which widens the arch by “gently” adding force.

The patient is seen about every 8 to 10 weeks. The arch width is measured and the spring is usually re-activated by adding “crimp stops” to hold the compressed spring in place. This appliance is very effective and requires little attention other than keeping it and the surrounding gums and teeth very clean.

Dr. Garrett recommends a fluoride rinse every night. Sometimes the teeth on which the E-arch is attached may loosen, allowing the arms of the appliance to position themselves over the biting surface of the teeth.

If this should happen, please call our office for an adjustment. Occasionally, the teeth to which the appliance is attached may come out. If this should happen, remove any parts possible and call us. Fortunately, in most cases, the E-arch has usually served its purpose by the time this could happen.

It is recommended that wax or EZO denture cushions be placed around any parts that may be irritated.

This appliance is a fixed appliance used to distalize (move back) molars to alleviate crowding. By making room, it allows Dr. Garrett to straighten the teeth without having to extract them. A TAD (Temporary Anchorage Device) is placed in the roof of the mouth The appliance has four “bands”, which are rings of metal that fit over 2 bicuspids and 2 molars. The front bicuspids are attached to the TAD as an “anchor.” From the anchor there are two more “arms” which have springs that push against the button to move the molars back.

The patient is seen about every 8 to10 weeks and the springs are activated by adding, “crimp stop” to hold back the compressed springs.

Once the molars are in position, the bicuspids will be pulled back and then front braces are applied for overall alignment.

As with all fixed appliances, the important issue is good oral hygiene. It is extremely important to keep the appliance, teeth and surrounding gum tissue very clean to prevent infection. It is also important to keep the tissue under the acrylic button clean.

Once the appliance is placed; the technician will give instructions on how to clean under the button and around all the parts.

As always, Dr. Garrett recommends the use of a fluoride rinse every night

The R.P.E. is an all-metal expansion appliance able to deliver expansion up to 12 mm in the upper arch in a short period of time.

The appliance is turned, or activated daily with the use of a small wrench and is usually attached to either 2 or 4 teeth.

After the insertion of the appliance, the patient is instructed on the care and cleaning of it. Soft foods are recommended for the first couple of days and should be cut into small pieces, so that food will not get “caught” in the appliance and cause gagging, such as spaghetti dangling down the throat.

It is recommended that wax or EZO Denture cushions be placed over any irritating parts and warm salt water be used to smooth the gums, should they become irritated. It is quite common for a large gap to develop between the upper front teeth. This is normal. The appliance will be checked every 3 to 4 weeks until desired expansion is achieved.

The Herbst Appliance is used in the treatment of jaw discrepancy (i.e., overjet, when the upper front jaw protrudes over the lower front jaw). In growing patients, it allows lower jaw growth. In older patients, it retrains the action of certain muscles. The average treatment time is approximately 9 months to 1 year, during which time the lower jaw is advanced initially about 3-4mm, and then incrementally, until the desired resting position is achieved.

The Herbst has telescopic arms which are attached to 4 crowns and by 4 hex screws. When the appliance is initially cemented into the mouth, it will have the lower jaw in an advanced position. Dr. Garrett will measure the progress approximately every 8 to 16 weeks and most likely continue to advance the appliance by adding “shims” to the arms to keep the jaw forward for continued correction.

Shims are small sleeves (or rings) of metal between 1 and 3 mm in length. The appliance is unhooked and the shims will slide on the arms for advancement and then the appliance is put back together.

There are times when a patient may open too wide and cause the arms to come out of the sleeves, if this should happen, the patient need only to open wide again and put the arms back. This may be a little tricky the first time or two, but most patients become proficient at this.

It is also recommended that the screws on the upper and lower portion of the Herbst be checked once a day to make sure they remain in place. This can be done with the small allen wrench provided.

When the Herbst is initially cemented, there is an adjustment period of about one-week. The limited range of motion for the jaw becomes “annoying” at first until the patient learns how to eat and talk with the Herbst.

Sometimes, there is extra saliva for a couple of days until the brain figures out that this is not food and then the extra saliva will subside.

The Herbst has some protrusive parts that may cause irritation, with the help of wax, cheek pads (which we provide) or EZO Denture Cushions. The initial discomfort can be managed with some helpful hints.

The most important item to remember with the Herbst appliance is cleanliness. It is extremely important for patients to brush the appliance, their teeth, and gums. Leaving any plaque on the teeth will result in irritation and infection.The appliance should look very shiny and not milky white (this is plaque). A nightly fluoride rinse is recommended.

This wire is usually attached to the permanent 6-year molars. It can be removable, but it is sometimes soldered to the molar bands. It is used primarily to “anchor” the molars while continuing the change and correcting the teeth bite.

Did you know flicking the lingual wire up and down with your tongue could break the wire and possibly loosen bands?

The Tongue Crib is used to inhibit the tongue from “pushing” the (front) anterior teeth when speaking. It is used to “retrain” the tongue posture in conjunction with speech therapy to aid in correction of the open bite. It also helps to break a thumb sucking habit.

Did you know playing with the tongue crib can cause the solder joints to break? OUCH!

The bonded bite plane is used to prevent the lower front teeth from “biting” into the tissue behind the upper front teeth thus causing damage to the tissue and teeth. By “opening” the bite in the front of the mouth, it allows the back teeth to erupt more in order to correct this problem.

The bonded bite plane is also used to correct a severe over-bite (the upper front teeth closing too far over the lower front teeth) in the same way.

The bonded bite plane is made by placing a small amount of bonding material to the backside of the upper teeth to create a triangular plane. They can also be placed on the molars. After correction, the doctor removes the plane by “polishing” it away with a special high-speed instrument.

It is important for patients to keep the tissue area surrounding the bite planes very clean. Watching out for hard foods that could break off these planes is also important. There are times when one of the planes may come off. This is okay, because as long as there is one remaining, the job can be accomplished.

Rubber bands or elastics contribute a lot to straighter teeth. They are marvels of physics. Attached to your braces or Invisalign aligners , elastics exert the force that creates the right amount of pressure to move teeth in directions that the braces alone can’t. They don’t work without you. It’s important to wear your elastics as prescribed.

Shannon has been with Garrett Orthodontics since Oct 1989. She assists Dr. Garrett during the initial consultation appointment as well as the coordination of all aspects of enrolling our new patients. She enjoys spending time with her husband, two grown daughters and grandchildren. Her hobbies include gardening and vacationing at the beach.

Amanda started her career in orthodontics with Dr. Garrett in May 2008. She enjoys interacting with the patients and assisting in treatment to create a beautiful smile. Amanda is highly skilled as an orthodontic clinical technician and also proficient in making the retainers for our patients. In her spare time she enjoys spending time with her family.

Paola joined Garrett Orthodontics in February 2012 with ten years of experience in orthodontics. She is married and has two young sons She enjoys spending time with her family and riding their motorcycle. Paola likes to get to know her patients personally and see their smiles before and after orthodontic treatment.

Pam is our experienced financial coordinator and has been with Garrett Orthodontics since Sept 2005. Patients and parents meet with Pam at the beginning of treatment and at that time she assists them in setting up individual financial arrangements. Pam also monitors all patient accounts and assists with Treatment Coordination. Pam is a Winchester native and Handley graduate. She enjoys spending time with Lance her son and reading, cooking and going to the beach.

Michele is originally from Michigan and has six years of clinical orthodontic experience. Michele spends her free time on the weekends racing her road bike in the Mid Atlantic region. She is currently the Women’s Cat ½ Virginia State Time Trial Champion and holds various other titles within the Mid Atlantic Region.

Susie has been the accounts payable and payroll supervisor since 1979. She was a graduate of the Medical College of Virginia School of Pharmacy in 1976 and practiced as a licensed pharmacist until 1990. Susie enjoys tennis, reading, traveling and especially spending time with her family. Susie and Dr. Garrett now have a new granddaughter Autumn Jane to spoil therefore grand parenting is her primary job.